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See a sample rate comparisonHCPCS J1097 (Omidria) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | 24 - Ambulatory Surgical Center None 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J1097 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J1097 by major payers:
$121.03
$124.15
$126.48
$123.94
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HCPCS J1097
5 of 25 sample ratesHigher to lower in this preview
Twin Cities Surgical Hospital LLC, Sutter Surgical Hospital - North Valley
Twin Cities Surgical Hospital LLC
$319.33Published rateOksana Yaskiv
North Shore-Lij Medical PC
$128.83Published rateBaptist Memorial Hospital-Jonesboro Inc, Nea Baptist Memorial Hospital
Baptist Memorial Hospital - Jonesboro Inc
$121.54Published rateRoane County Medical Center, Roane Medical Center
Roane County Medical Center
$121.54Published rateVenkat Subramaniam
$109.38Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J1097 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1097 code is part of the Drugs Administered Other than Oral Method services used for Drugs, Administered by Injection. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J1097 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| J1096-HCPCS | Low | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg |
| J1097-HCPCS | Low | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml |
| J1100-HCPCS | Low | Injection, dexamethasone sodium phosphate, 1 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J1097. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1097 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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